Are the New Mammogram Recommendations Legitimate or the Beginning of Health Rationing?

The United States Preventive Services Task Force (USPSTF), whose job it is to review the effectiveness of preventive services and make recommendations, has come out with its recommendation that women who are otherwise at normal risk for breast cancer forgo mammograms until the age of 50, receive them every 2 years up until the age of 75, and not bother with breast self-exams. The firestorm greeting their recommendation has been immediate and fierce.

Organizations such as American Cancer Society and Susan G. Komen For the Cure are in the midst of ramping up their visibility in order to convince women of the need for early, frequent mammograms and self exams, so this recommendation flies in the face of their own campaign. It doesn't help any that, while USPSTF consists of an independent panel, the organization itself is funded and appointed by the government of the United States. According to the website of The Agency for Healthcare Research and Quality (AHRQ), formerly known as the Agency for Health Care Policy and Research, USPSTF is under their auspices. While AHRQ's mission of improving "the quality, safety, efficiency, and effectiveness of health care for all Americans" sounds positive, the USPSTFS, according to Newsweek, "helps insurers decide what procedures are covered and which aren't." And given the current climate of intense debate over health care and health insurance reform, the timing couldn't be worse.

According to numerous news reports, a lot of people fear this is the beginning of what they see as government health care rationing. The various cancer societies have been gaining momentum and women have been bombarded with the message that early mammograms save countless lives; that breast self-exams catch cancers even earlier when they are more treatable; that breasts are so changeable, mammograms must be done frequently. Women seemingly flock to be interviewed by magazines in droves to report that if it weren't for their mammogram they would have died of the breast cancer discovered early enough to treat. But is this true?

According to The New York Times, medical experts say the risks of mammograms before the age of 50 are very real. The mammograms are good at finding irregularities, but, says Dr. Heidi Nelson, doctors don't really know for sure what risks those irregularities pose. This leads to a whole lot of anxiety, expense, and unnecessary tests like biopsies for women who don't have cancer after all. And even when a cancerous tumor is discovered, for the majority of women that cancer would never have spread or grown in to a problem, meaning the trauma of unnecessary surgery, chemo and radiation with all their side effects for women who would have died of something else had the tumor not been discovered.

The statistics, according to the Annals of Internal Medicine, show only one woman out of 1,900 who are between the ages of 40 and 49 was saved by a timely mammogram. If you are that one woman, then of course, that mammogram would have been important to you, but statistically many doctors do not think it is worth the trouble it causes all the other women.

The current recommendations are really not that revolutionary. They differ only slightly from the same organization's 2002 recommendations. There are all kinds of caveats about the recommendation, such as whether the woman has an increased family risk of breast cancer, and the cautions not to have early mammograms seem to be based on a body of evidence that bear up under scrutiny. Most of the insurance companies as well as Medicare have no plans, at least presently, of refusing to pay for mammograms for younger women. As for breast self-exams, it isn't as if anyone can prevent you from doing them. Some see these new mammogram recommendations as a real problem, but others think this is a tempest in a teapot, heightened by the current tense political climate, and not a real threat to women after all.

http://www.annals.org/content/151/10/727.abstract
http://www.ahrq.gov/clinic/pocketgd09/gcp09s2.htm#BreastScreening (recommendations in 2002 by USPSTF)
http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm
http://blog.newsweek.com/blogs/thehumancondition/archive/2009/11/17/the-real-with-mammograms-they-re-too-good-at-finding-issues-we-don-t-understand.aspx